SCHWARTZ APPLIANCE AND LIP BUMPER AS TREATMENT MODALITIES FOR MANDIBULAR CROWDING IN MIXED DENTITIONS
Abstract
Dental crowding is the most common form of malocclusion. It is more pronounced in the mandible than in the maxilla and tends to increase with age. Depending on the degree of space deficiency and the age of the children the prevalence of dental crowding can be as high as 50%. Schwartz appliance and lip bumper have been widely used as an early treatment for increasing lower dental arch dimensions. The aim of this review is to evaluate the scientific research about the efficacy of Schwartz appliance and lip bumper and compare the changes caused by the two appliances in addressing mandibular crowding in the mixed dentition. A comprehensive literature search on the electronic databases: PubMed, Cochrane Library and Google Scholar was performed. Also, a search of the reference lists of included studies was conducted, to ensure comprehensive coverage of the literature. Search terms included "Schwartz appliance" OR "removable appliance" AND "lip bumper" OR "fixed appliance" AND "mandibular crowding" AND "mixed dentition" OR "early dentition". The search resulted in identifying several studies that met the inclusion criteria.Results show that both Schwartz appliance and lip bumper can effectively improve mandibular crowding in mixed dentition, although the extent and type of changes produced by these appliances may vary. Schwartz appliance is more effective in increasing inter canine width, while the lip bumper has more effect on increasing the arch length. Patient compliance as well as treatment duration are important factors that can have an effect on the success of orthodontic treatment. Schwartz appliance and lip bumper are effective in alleviating mandibular crowding, thus providing cost-effective and simple treatment in mixed dentition. The choice of the appliance should be based on the individual patient’s needs and treatment goals. Further research is needed to evaluate and compare the stability and long-term effects of these two appliances as well as the need for further fixed orthodontic treatment.
Key words: Schwartz appliance, lip bumper, mandibular crowding, mixed dentition
References
2. Proffit WR, Fields HW, Larson B, Sarver DM. Contemporary orthodontics. 6th ed. Elsevier/Mosby; 2018.
3. Tai K, Park JH, Mishima K, Shin JW. 3-Dimensional cone-beam computed tomography analysis of transverse changes with Schwarz appliances on both jaws. Angle Orthod. 2011 Jul;81(4):670–7.
4. Cobourne MT, editor. Orthodontic Management of the Developing Dentition: An Evidence-Based Guide. Springer; 2017.
5. Sampson WJ, Richards LC. Prediction of mandibular incisor and canine crowding changes in the mixed dentition. Am J Orthod. 1985 Jul;88(1):47–63.
6. Sinclair PM, Little RM. Maturation of untreated normal occlusions. Am J Orthod. 1983 Feb;83(2):114–23.
7. Moorrees CF, Chadha JM. Available space for the incisors during dental development--a growth study based on physiologic age. Angle Orthod. 1965 Jan;35:12–22.
8. Solomon MJ, English JD, Magness WB, McKee CJ. Long-term stability of lip bumper therapy followed by fixed appliances. Angle Orthod. 2006 Jan;76(1):36–42.
9. Nevant CT, Buschang PH, Alexander RG, Steffen JM. Lip bumper therapy for gaining arch length. Am J Orthod Dentofacial Orthop. 1991 Oct;100(4):330–6.
10. Tai K, Hotokezaka H, Park JH, Tai H, Miyajima K, Choi M, et al. Preliminary cone-beam computed tomography study evaluating dental and skeletal changes after treatment with a mandibular Schwarz appliance. Am J Orthod Dentofacial Orthop. 2010 Sep;138(3):262.e1-262.e11; discussion 262-263.
11. Tai K, Park JH. Dental and Skeletal Changes in the Upper and Lower Jaws after Treatment with Schwarz Appliances Using Cone-Beam Computed Tomography. 2011. Available from: https://www.jocpd.com/articles/10.17796/jcpd.35.1.b21t44rj34027603
12. Shen T, Zhao B, Wang C, Xiao Y, Han Y, Zhao G, et al. Efficacy of different designs of mandibular expanders: A 3-dimensional finite element study. American Journal of Orthodontics and Dentofacial Orthopedics. 2020 May 1;157(5):641–50.
13. Bergersen EO. A cephalometric study of the clinical use of the mandibular labial bumper. Am J Orthod. 1972 Jun;61(6):578–602.
14. Grossen J, Ingervall B. The effect of a lip bumper on lower dental arch dimensions and tooth positions. Eur J Orthod. 1995 Apr;17(2):129–34.
15. O’Donnell S, Nanda RS, Ghosh J. Perioral forces and dental changes resulting from mandibular lip bumper treatment. Am J Orthod Dentofacial Orthop. 1998 Mar;113(3):247–55.
16. Osborn WS, Nanda RS, Currier GF. Mandibular arch perimeter changes with lip bumper treatment. Am J Orthod Dentofacial Orthop. 1991 Jun;99(6):527–32.
17. Raucci G, Pachêco-Pereira C, Elyasi M, d’Apuzzo F, Flores-Mir C, Perillo L. Short- and long-term evaluation of mandibular dental arch dimensional changes in patients treated with a lip bumper during mixed dentition followed by fixed appliances. Angle Orthod. 2016 Sep;86(5):753–60.
18. Griswold O, Li C, Orr JC, Boucher NS, Shah SR, Chung CH. Lip Bumper Therapy Does Not Influence the Sagittal Mandibular Incisor Position in a Retrospective CBCT Study. J Clin Med. 2022 Oct 13;11(20):6032.
19. Davidovitch M, McInnis D, Lindauer SJ. The effects of lip bumper therapy in the mixed dentition. Am J Orthod Dentofacial Orthop. 1997 Jan;111(1):52–8.
20. Quinzi V, Caruso S, Mummolo S, Nota A, Angelone AM, Mattei A, et al. Evaluation of Lower Dental Arch Crowding and Dimension after Treatment with Lip Bumper versus Schwarz Appliance. A Prospective Pilot Study. Dent J (Basel). 2020 Apr 10;8(2):34.
21. Hashish DI, Mostafa YA. Effect of lip bumpers on mandibular arch dimensions. Am J Orthod Dentofacial Orthop. 2009 Jan;135(1):106–9.
22. Santana LG, de Campos França E, Flores-Mir C, Abreu LG, Marques LS, Martins-Junior PA. Effects of lip bumper therapy on the mandibular arch dimensions of children and adolescents: A systematic review. Am J Orthod Dentofacial Orthop. 2020 Apr;157(4):454-465.e1.
23. Little RM, Riedel RA, Stein A. Mandibular arch length increase during the mixed dentition: postretention evaluation of stability and relapse. Am J Orthod Dentofacial Orthop. 1990 May;97(5):393–404.
24. Murphy CC, Magness WB, English JD, Frazier-Bowers SA, Salas AM. A longitudinal study of incremental expansion using a mandibular lip bumper. Angle Orthod. 2003 Aug;73(4):396–400.
